ECDC TECHNICAL REPORT

ECDC TECHNICAL REPORT

Interim guidance for environmental cleaning in non-healthcare facilities exposed to SARS-CoV-2 18 February 2020

Scope of this document This document aims to provide guidance about the environmental cleaning in non-healthcare facilities (e.g. rooms, public offices, transports, schools, etc.) where confirmed COVID-19 cases have been before being admitted to hospital. This guidance is based on the current knowledge about SARS-CoV-2 and evidence originating from studies on other coronaviruses.

Target audience

Competent bodies in EU/EEA Member States.

COVID-19 The causative agent involved in the current outbreaks of coronavirus disease 2019 (COVID-19), SARS-CoV-2 (genus: Betacoronavirus ), belongs to the family of Coronaviridae , a large family of enveloped, positive-sense single-stranded RNA viruses. Coronaviruses are transmitted in most instances through large respiratory droplets and contact transmission, but other modes of transmission have also been proposed. The time of survival and the conditions affecting SARS-CoV-2 viability in the environment are currently unknown. According to studies assessing the environmental stability of other coronaviruses, the severe acute respiratory syndrome coronavirus (SARS-CoV) is estimated to survive several days in the environment, and the Middle East respiratory syndrome-related coronavirus (MERS-CoV) can withstand more than 48 hours at average room temperature (20 °C) on different surfaces [1-3]. Environmental cleaning options Due to the potential survival of the virus in the environment for several days, the premises and areas potentially contaminated with SARS-CoV-2 should be cleaned before their re-use, using products containing antimicrobial agents known to be effective against coronaviruses. Although there is lack of specific evidence for their effectiveness against SARS-CoV-2, cleaning with water and household detergents and use of common disinfectant products should be sufficient for general precautionary cleaning. Several antimicrobial agents have been tested against different coronaviruses (Table 1). Some of the active ingredients, e.g. sodium hypochlorite (contained in the household bleach) and ethanol are widely available in non- healthcare and non-laboratory settings.

Suggested citation: European Centre for Disease Prevention and Control. Interim guidance for environmental cleaning in non- healthcare facilities exposed to SARS-CoV-2. ECDC: Stockholm; 2020.

© European Centre for Disease Prevention and Control, Stockholm, 2020

ECDC TECHNICAL REPORT

Interim guidance for environmental cleaning in non-healthcare facilities exposed to SARS-CoV-2

A recent paper which compared different healthcare germicides [4] found that those with 70% concentration ethanol had a stronger effect on two different coronaviruses (mouse hepatitis virus and transmissible gastroenteritis virus) after one minute contact time on hard surfaces when compared with 0.06% sodium hypochlorite. Tests carried out using SARS-CoV showed that sodium hypochlorite is effective at a concentration of 0.05 and 0.1% after five minutes when it is mixed to a solution containing SARS-CoV [5]. Similar results were obtained using household detergents containing sodium lauryl ether sulphate, alkyl polyglycosides and coco-fatty acid diethanolamide [5]. Table 1. Antimicrobial agents effective against different coronaviruses: human coronavirus 229E (HCoV-229E), mouse hepatitis virus (MHV-2 and MHV-N), canine coronavirus (CCV), transmissible gastroenteritis virus (TGEV), and severe acute respiratory syndrome coronavirus (SARS-CoV) 1

Antimicrobial agent Concentration

Coronaviruses tested

References

Ethanol

70%

HCoV-229E, MHV-2, MHV-N, CCV, TGEV

[4,6,7]

Sodium hypochlorite

0.1–0.5% 0.05–0.1%

HCoV-229E SARS-CoV

[6] [5]

Povidone-iodine

10% (1% iodine) HCoV-229E

[6]

Glutaraldehyde

2%

HCoV-229E

[6]

Isopropanol

50%

MHV-2, MHV-N, CCV

[7]

Benzalkonium chloride

0.05%

MHV-2, MHV-N, CCV

[7]

Sodium chlorite

0.23%

MHV-2, MHV-N, CCV

[7]

Formaldehyde

0.7%

MHV-2, MHV-N, CCV

[7]

Cleaning approaches The use of 0.1% sodium hypochlorite (dilution 1:50 if household bleach at an initial concentration of 5% is used) after cleaning with a neutral detergent is suggested for decontamination purposes, although no data on the effectiveness against the SARS-CoV-2 are available. For surfaces that could be damaged by sodium hypochlorite, 70% concentration of ethanol is needed for decontamination after cleaning with a neutral detergent. Cleaning should be performed using the proper personal protective equipment (PPE). The correct donning and doffing of PPE should be followed; further information on the donning and doffing procedures can be found in the ECDC Technical Document ‘ Safe use of personal protective equipment in the treatment of infectious diseases of high consequence ’ [8]. Disposable PPE should be treated as potentially infectious material and disposed in accordance with national rules. The use of disposable or dedicated cleaning equipment is recommended; non-single use PPE should be decontaminated using the available products (e.g. 0.1% sodium hypochlorite or 70% ethanol). When other chemical products are used, the manufacturer’s recommendation should be followed and the products prepared and applied according to them. When using chemical products for cleaning, it is important to keep the facility ventilated (e.g. by opening the windows) in order to protect the health of cleaning personnel.

The following PPE items are suggested for use when cleaning facilities likely to be contaminated by SARS-CoV-2:

 Filtering face pieces (FFP) respirators class 2 or 3 (FFP2 or FFP3)  Goggles or face shield  Disposable long-sleeved water-resistant gown  Disposable gloves.

All frequently touched areas, such as all accessible surfaces of walls and windows, the toilet bowl and bathroom surfaces, should be also carefully cleaned. All textiles (e.g. bed linens, curtains, etc.) should be washed using a hot-water cycle (90 °C) and adding laundry detergent. If a hot-water cycle cannot be used due to the characteristics of the tissues, specific chemicals should be added when washing the textiles (e.g. bleach or laundry products containing sodium hypochlorite, or decontamination products specifically developed for use on textiles).

Contributing ECDC experts

In alphabetical order: Agoritsa Baka, Orlando Cenciarelli

1 This list is based on antimicrobial agents that are mentioned in analysed peer-reviewed scientific literature reported in the references. It is not necessarily exhaustive, nor does it imply that other similar antimicrobial agents are less effective. ECDC does not endorse nor recommend the use of any specific commercial products.

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ECDC TECHNICAL REPORT

Interim guidance for environmental cleaning in non-healthcare facilities exposed to SARS-CoV-2

References

1. van Doremalen N, Bushmaker T, Munster VJ. Stability of Middle East respiratory syndrome coronavirus (MERS- CoV) under different environmental conditions. Eurosurv. 2013 Sep 19;18(38). 2. Otter JA, Donskey C, Yezli S, Douthwaite S, Goldenberg SD, Weber DJ. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination. The Journal of hospital infection. 2016 Mar;92(3):235-50. 3. Lai MY, Cheng PK, Lim WW. Survival of severe acute respiratory syndrome coronavirus. Clinical infectious diseases. 2005 Oct 1;41(7):e67-71. 4. Hulkower RL, Casanova LM, Rutala WA, Weber DJ, Sobsey MD. Inactivation of surrogate coronaviruses on hard surfaces by health care germicides. American journal of infection control. 2011;39(5):401-7. 5. Lai MYY, Cheng PKC, Lim WWL. Survival of severe acute respiratory syndrome coronavirus. Clinical Infectious Diseases. 2005;41(7):e67-e71. 6. Sattar SA, Springthorpe VS, Karim Y, Loro P. Chemical disinfection of non-porous inanimate surfaces experimentally contaminated with four human pathogenic viruses. Epidemiology & Infection. 1989;102(3):493- 505. 7. Saknimit M, Inatsuki I, Sugiyama Y, Yagami K. Virucidal efficacy of physico-chemical treatments against coronaviruses and parvoviruses of laboratory animals. Experimental animals. 1988;37(3):341-5. 8. European Centre for Disease Prevention and Control (ECDC). Safe use of personal protective equipment in the treatment of infectious diseases of high consequence. Stockholm: ECDC; 2014. Available from: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/safe-use-of-ppe.pdf .

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